Outlook from the Hutchhttps://outlookfromhutch.com
A blog on aging and the mindThu, 08 Jun 2017 15:40:07 +0000enhourly1http://wordpress.com/https://secure.gravatar.com/blavatar/4c4db5ddba7a72db9bd84c0dd0852feb?s=96&d=https%3A%2F%2Fs2.wp.com%2Fi%2Fbuttonw-com.pngOutlook from the Hutchhttps://outlookfromhutch.com
Apprehensions of Alcohol in Old Agehttps://outlookfromhutch.com/2015/09/23/apprehensions-of-alcohol-in-old-age/
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I have become used to the paradox that Medics, met one at a time, all seem to drink enthusiastically, that reported alcohol abuse by medics steadily increases but, at dinners given by Medical Faculties of Universities, I must expect very little alcohol. Medics feel obliged to signal to the world and each other that alcohol is a delicious toxin that significantly increases risks of liver damage, bowel cancer, diabetes, heart disease, neurological problems and, at least in mid-life, dementias [ eg 1 and alarmingly many other studies ]. They have not always taken this line. During the 18tth and 19th centuries physicians were happy to prescribe patients a bottle of wine a day and, even as late as the 1960’s, well-heeled parents would provide cases of Burgundy to fortify their pregnant daughters. Alcohol has been around since at least 7000-6650 BC when a fermented drink made of grapes, hawthorn berries, honey, and rice was drunk by Han Chinese. Babylonian contemporaries made do with quite nasty wheat beer. Wine is suspected in Georgia in 6000 BC, and confirmed in Iran in 5400 BC. The Koran forbids alcohol, licensing duller intoxications from chewed quat-leaves, but the Old Testament gives it a good press: psalm 104:15 praises “wine that maketh glad the heart of man…” and Proverbs 31: 6-7 recommends alcohol as a help for the dying and depressed to forget misery. We delight in stories featuring Winston Churchill’s wartime consumption of Champagne and Brandy, and other notables whose prodigious consumption failed to undermine remarkable achievements. Especially when they are as witty as Churchill, answering a Mormon guest’s “Mr Churchill, the reason I do not drink is that alcohol combines the kick of the antelope with the bite of the viper” with “All my life I have been searching for a drink like that”. Alas, though Churchill survived into his 80’s, he became so incapacitated by the effects of multiple small strokes that, if he were less venerated, he would have been diagnosed as a vascular dement. Others did not do so well. Pitt the younger drank several bottles of Port a day but it did not improve his performance in the Commons and he died young. The recent long-delayed post mortem on Richard III reveals that he drank at least a bottle of wine a day – but perhaps died too early ( 36) of violence for long term effects to become apparent. Until the 19th century the life-shortening lethality and brain destruction of alcohol were not recognised because there were so very many other ways to die young, and paths for alcohol to kill you before it noticeably affects your mind.

Scores of studies have investigated whether drinking in early or middle age impairs memory and intelligence and increases the risk of dementias and what kinds of drinks are most harmful. The least ambiguous message is that “bingeing” – drinking a great deal of alcohol on single occasions, but regularly, does considerable harm. A convincing Finnish longitudinal twin study [ 2 ] reports that binges (defined as drinking at least a bottle of wine or 5 bottles of beer) once a month or more often during middle age definitely increases the risk of Alzheimer’s disease as you get older. The effects of regular consumption of smaller amounts are less clear.

Surveys in the USA, UK and Australia all agree that lifelong alcohol consumption is much lower in women than men, peaks in the late 20’s and early 30’s for both sexes and then declines quite sharply and that, overall, alcohol consumption is declining. However, during recent decades there has been a trend in all three countries for the late middle aged and elderly to drink increasingly more year on year. A 2015 survey of 9248 elderly drinkers [3] found that 21.4%, or one in five, drank above safe limits (21 units, – i.e. equivalents to 25 175 ml glasses of wine a week). Older unsafe drinkers tend to be male and Irish. At all ages Africans, Caribbeans and Asians drink less than Whites. Self-reports of risky drinking decline in old age but, presumably, this is partly because fewer enthusiastic drinkers survive into their late 70’s and 80’s.

A much-publicised finding from more recent studies is that, among the elderly, things seem to be getting worse. A survey of mortality statistics for 1991 found 257 men and 271 women aged over 75 died of alcohol related conditions and by 2012 this rose to 580 men and 285 women. The trend was even stronger for middle-aged women aged 59 to 75.

Rahul Rao and Brian Draper [4] report that between 2005 and 2015 hospital admissions for alcohol-related brain damage among people aged 60 + rose by 140%, contrasting with 10% for 15 to 59 year olds. Socio-economic deprivation is a very strong predictor of risky drinking but this cannot be the main reason because the trends are most marked in prosperous baby-boomers rather than desperate destitutes. Dr Mark Ashworth, a GP and primary care researcher, analysed health records of 27,991 Londoners aged 65 years and over [BMJ open] Of these 9248, (21%), drank more than the recommended safe limits and unsafe drinking was more frequent in the elderly than the population average. Among the 5% of heaviest drinkers men drank over 49 units – more than a bottle of whisky – and women 23 units a week, almost 2 bottles of wine a week. This study again found that drinking was more common among Irish and white British than among Caribbeans, Africans or Asians. Medical commentators suggest that GPs are not sufficiently alert for signs of problem drinking in the prosperous, and apparently well-functioning elderly and that bored or depressed elderly who can easily afford tempting alcohol may unwittingly fall into a routine of excessive consumption.

All studies note that in old age heavier drinking is often a socially invisible activity, often solitary rather than gregarious, carried out inconspicuously at home, usually in the evenings, and typically provoked by boredom, depression, and events like bereavements and other inevitable realities that can make old age difficult. I am sorry to hear this because I seem, at least at the moment, to have no sorrows to drown, and my drinking seems a jolly process ( for me if not for those who put up with me) a heart-gladdener rather than a misery-muffler. I cannot argue against the convincing and dire warnings from nearly all studies that have not been sponsored by the alcohol industry. Neverthless it is a personal relief to find that at least one large, apparently well-conducted and honest study offers a dram of comfort. In 2011 Siegfried Weverer and 9 others funded by the German Primary Health Care trust recruited 3,202 people aged 75+ who were free of dementia when first seen. Three years later 217 had suffered Alzheimer’s, Picks or multi-infarct dementias. Within a range of moderate drinking and after controlling for a number of potential confounders, current alcohol consumption was associated with a 29% decrease in overall dementia incidence with a 42% decrease specifically in Alzheimer’s. This sample is unusually old compared to those assessed in other studies but the authors point to similar findings in a study of drinkers aged 85 and older and also in slightly younger groups. Again it may be that we are dealing with a survivor effect. Those who reach older ages have always led pretty sober lives. For me a particularly congenial minor finding from the Weverer study is that beer and spirits work just as well as wine – most other studies have found benefits from wine alone. Another is that huge (up to 490,000 men and women ­) and methodologically convincing studies find that moderate drinking prolongs life by reducing risks of many different diseases. [ 5].

There are unresolved puzzles such as why alcohol in middle age seems to be strongly associated with increased risk of dementias, damage to the hippocampus and consequent memory loss while modest drinking at much older ages seems to do good. Part of the solution must be that the oldest people studied are survivors left after all the ravages of drinking have killed off many of their less temperate peers. However this may be, just at this moment I am in no mood to moderate my relief by exploring this issue any further in the dusty journals. It is six PM and the gin, the ice, the lemon and the frisky tonic water will all be there as soon as I open the fridge. The ingredients for a fine Negroni are also to hand. Muttering to myself “Moderation, Moderation, always Moderation” I shall take steps to tastefully prolong my life and so, also, what remains of my mind.

Liu, K. (2015). Health-related quality of life and related factors among elderly people in Jinzhou, China: a cross-sectional study. Public Health, 129, 667-673.

Death has become an acceptable and even a fashionable topic. Conversations about death are becoming speculations about the amenities of bland final visits to Holland or Switzerland. Very soon, as entrepreneurs recognize and grasp the rich opportunities, such cosy suburban deaths will be only the economy-end of a spectrum of choices stretching to deluxe departures, precisely timed at sunrise or sunset in mountain, woodland or tropical beach locations with optional champagne, vintage brandy, succulent canapes, background music of choice, professional recording of last words and terminal selfies. We are becoming Cool about Death, but are not yet de-sensitized to a much more disturbing issue: Before we can splash out our savings on a Premium Last Passage we may become demented and a pitiful burden to ourselves and any who care for us. What are the odds of such disasters and can we do anything to tilt them in our favour ?

All studies agree that our chances of our escaping dementia are much better than we might fear. The most common dementia is Alzheimer’s disease (AD) a neurodegenerative condition with brain changes including characteristic patterns of progressive nerve-cell deaths associated with changes in protein metabolism and, on microscopic examination of the brain marked by scar-like plaques and “neurofibrilliary tangles”. These first appear in the neocortex and eventually spread to the hippocampus. Another neurodegenerative condition, Pick’s Disease, or Lewy Body Dementia is, happily, much less common. After neurodegenerative conditions the most common dementias are associated with problems with brain blood supply, such as ruptures and blockages of tiny blood vessels causing deaths of small areas of brain tissue that they serve. Like the risk of AD the risk of such Vascular Dementias increases with age. A very large 1994 Canadian Study of Health and Aging [ 1 ] found that overall incidence of all kinds of dementias was 23% for those aged 85 to 89 and increased to 40% in a 90-94 year old group and 58% in a relatively small group who were over 95. Over all age-groups AD accounted for 75% and vascular dementia for 13% of all dementias. Incidence of AD cases increased faster than of Vascular Dementia cases after 65 and was higher in the 85+ group than in those aged 65 to 85. It is useful to remember that these numbers refer to survivors in each age group. This means that most people in this, and all other populations die without experiencing dementias. The amount and quality of comfort you get from this thought will depend, of course, on your personal views on life and death. I find it rather cheering.

What factors increase risk of these obnoxious conditions and what can we do to improve our chances of avoiding them? Analyses comparing results of many studies suggest that the Canadian figures are quite typical because the risks of dementias do not much differ between countries [2]. As these show, the risk of dementias markedly increases with age. Some analyses combining data from several studies suggest that this accelerated increase in risk with age slows down in the late 80’s and 90’s but other surveys find a linear increase continuing after 85. Diagnoses are sometimes uncertain because brains of older people who experience only very mild mental declines, often called “Mild Cognitive Impairment” often show AD-like changes in nerve cells. On the other hand Mild Cogntive Impairment is a strong risk factor for future AD and other dementias. A different neurodegenerative dementia, Pick’s Disease, or “Lewy Body Dementia” is relatively rare, and so less well documented, but is also age-related. Probably a more common neurodegenerative dementia than Picks associated with Parkinson’s disease, in which it is certainly not an inevitable outcome but affects about 40% of sufferers [3].

As these numbers suggest the strongest risk factor for all dementias is getting old. The reason for the increased incidence of dementias, melodramatically described by the media as an “epidemic” or “plague”, is not that they are contagious or are becoming more common at any particular age but just that more of us now survive to experience them. A crucial comfort is that in this context “Age” is not the remorseless tally of our birthdays, “Calendar Age”, but “Biological Age” the amount and rate at which our bodies and brains have changed and how fit we still remain. The check-list of risks is almost identical for both Alzheimer’s and Vascular Dementias because most factors that impair well-being increase risk of both. One exception is that a genetic factor, apolipoprotein e4-allele seems to increase risk of AD and, in particular, increases the risk from all other unhelpful lifestyle factors. Smoking is very bad news, as is being fat, especially if we have put on weight during or before middle age and not slimmed down since. Nevertheless even elderly long-term fatties should never surrender the struggle to lose weight because this still significantly reduces risks. Diabetes increases the risk of all dementias [4] and so, most definitely, does cardiovascular disease and taking little or no exercise. The incidence of AD is greater in women than in men but there is encouraging evidence that this is not the case in women who have had Hormone – Replacement Therapy for at least 10 years.

We have all become weary and disheartened at being continually nagged to take more exercise because, apart from not smoking but this is probably the most effective thing we can do to extend and increase the length of our lives and our daily pleasure in them. We need aerobic exercise that benefits our hearts and lungs and so the blood and oxygen supply to our brains but it is surprising, and to me profoundly encouraging how very little exercise can make a difference. For example a useful study found that incidence of AD in a 3 year period was significantly less in elderly who walked 2.0 miles a day compared to 0.25 miles a day and even the lower mileage gave a slight but real advantage over total torpor. Another reassuring study [5] found that even gentle activities such as doing odd-jobs about the house, gardening and generally pottering about reduced the risk relative to that of deep inertia. It is mean to be a spoilsport about such a congenial result. I, for one, deeply wish to trust it but there is a small problem of participant selectivity: was pottering the cause or only a symptom of relative preservation in those who were chosen for assessment? Had those who could not even potter around a bit already crossed a frontier from which they could not return?

Academic colleagues are smug to learn that longer education lowers the risk of Alzheimer’s and other dementias. There is the usual problem of interpretation because longer education tends to buy a more comfortable life in non- toxic environments with better diet and more attention to health care and so lower risk of pathologies such as cardiovascular problems and diabetes that are risk factors for dementias of all kinds.

It is difficult, and perhaps even gauche to scrabble for a cheerful note on which to end a post on dementias. Studies of alcohol consumption probably provide the only glint of amusement we can wring out of this cheerless topic. A very large, and apparently well-conducted study in the Dordogne found that consumption of even 5 standard glasses of wine a day did not increase risks of dementia and that men and women drinking smaller amounts had slightly lower risks than tee-totalers. Convincing studies based in Copenhagen [6] and in Rotterdam [7], where wine production is not a significant part of the economy, found that modest daily consumption (1-2 glasses) of beer and spirits had no bad effects, and that drinking modest quantities of wine actually reduced risks. This inspires me to a new life plan: whenever anxiety that I may soon dement peaks to the point at which I must take action I shall avoid my nearest bottle-shops and manfully step out to the furthest that I can reach and buy as good a bottle of wine as I can afford. Beaujolaise if they have it.

Ebly, E. M., Parhad, I. M., Hogan, D. B., & Fung, T. S. (1994). Prevalence and types of dementia in the very old Results from the Canadian Study of Health and Aging.Neurology, 44(9), 1593-1593.

Even for Aging Studies August is the Silly Season. What people really want to be told about old age is how to avoid it entirely or, paradoxically, how to prolong it indefinitely by putting off dying as long as possible. Hence a babble of late-summer-feel-good advice in Newspapers and Twitter on how we may manage this.

My favorite in this summer harvest of feel-good stories is a new recycling of the hoary anecdotes so often told about apocryphal relatives or acquaintances who lived to a remarkable and rumbustious old age by ignoring temperate behaviour. Agnes Fenton, of Fenton, New Jersey, believes that she reached 110 on August 1 st this year because, for the last 70 years, she has drunk at least 3 pints of Millers High Life Beer and a shot of Johnny Walker Blue Whisky every day. The site, drinkaware.com, sponsored by Koparberg Premium Cider of Sweden, adds comments by Dr Jiangou Fang, of Lanzhou University on an article in the Journal of Agricultural and Food Chemistry suggesting that regular beer drinking may stave off Parkinson’s, Alzheimers and other dementias because hops contain a benevolent flavonoid, xanthohumol. This is excellent news for those of us scrabbling for reasons to trust the increasingly dicey evidence that copiously drinking red wine may also prolong life and benefit the aging brain.

Another encouraging Chinese study published on 4 August 2015 (BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h3942 ) found that in samples of 199, 293 men and 288, 082 women aged 30 to 79 ( excluding participants with cancer, heart disease, and stroke at baseline) people who reported eating spicy foods on 6 or 7 days a week showed a 14% reduction in mortality compared to those who ate them on 1 day a week or less. A gratifying detail is that the benign interaction between spice and longevity is stronger in people who also drink alcohol. Though the interaction between the effects of alcohol and spice, at p = .03, is not as robust as we would wish this is still an encouragement for British Males who can now claim that their traditional pungent Curry Dinners following evenings in pubs are not a luxury but an essential regimen for body and brain maintenance.

A slightly less encouraging finding by Danxia Yu and 10 others, (PLOS Med May 26, 2015) comes from their study of the effects of very faithfully keeping to a diet based on the US Dietary Guidelines for Americans. Between 2002 and 2009 among 84,735 persons, with below average incomes, aged from 40 to 79, who were citizens of the 12 South Eastern States of the USA. fewer of those who rigorously kept to the diet died. This is interesting information but, given the wide difference between junk-food and the US Guideline Diet, perhaps not surprising. For a cognitive gerontologist there is also the issue whether individuals who were sufficiently motivated and steadfast to maintain the Guideline Diet were not also different in important ways from those who could not do so. Comparisons of obesity in the two populations would also be useful.

Keeping to a sensible diet can be difficult, especially if you are poor. However meditation and looking on the sunny side of life are available, free, to all of us. Scores of recent articles insist that cheerful and positive people live longer and so retain their mental abilities later than the morose or miserable. This tells us little new because there are many reasons for being more morose than average: among these are socio-economic disadvantage and illnesses that also shorten our lives and speed mental decline. Similar problems apply to the many studies showing that people with high youthful scores on intelligence tests are likely to live longer than their less able peers. These are particularly encouraging to self-satisfied academics but we must remember that higher intelligence buys many things. Among these are greater affluence and so better medical care, a more salubrious lifestyle and environment, better education in healthy living and choice of diet and even perhaps more and better wine, beer, whisky and curries.

The August prize for the best advice on how to live (nearly) forever must go to a story giving cutting edge scientific credence to a sanguinary medieval aspiration. Many sources, including the Guardian (Aug 4, 2015) comment on a paper in Nat Med 2014 (6) 659-63 by S.A. Villeda and 17 others claiming that “ Young blood reverses age-related impairments in cognitive function and synaptic plasticity in mice”. This has a titillating range of historical resonance: from lethal C16 th to C18th experiments in transfusion of blood from young to elderly humans, through C19 overtones of Vampirism, to warnings by C20 Science Fiction writers that visions of capitalists draining the lifeblood of the poor may transcend metaphor to become horrid reality. With added revivals of Medieval speculations that not only the age, but the quality of the fluid is crucial. I hope that my GP takes note and eagerly look forward to being prescribed at least two litres of Extra Virgin a week. As soon as our National Health Service gets its act together.

]]>https://outlookfromhutch.com/2015/08/06/living-nearly-forever/feed/1pmar76alcoholchilliesNew possibilities for Old Academicshttps://outlookfromhutch.com/2015/07/30/new-possibilities-for-old-academics/
https://outlookfromhutch.com/2015/07/30/new-possibilities-for-old-academics/#respondThu, 30 Jul 2015 19:50:35 +0000http://outlookfromhutch.com/?p=575Continue reading →]]>The long hours between Lunch and Gin are enlivened by a new excitement. When I was young I timidly offered articles and book proposals to supercilious journal editors and publishers who, mostly, rejected them. Now that I am old and unproductive publishers e-mail blandishments to contribute “invited” articles on Urology, Quantum-Mechanics and Neurophysiology to “field-breaking” journals that “will provide an appropriate setting for my distinguished and important work”. I have even been offered Associate Editorship of a “mould-breaking (sic) International Journal of Gerontological and Geriatric Studies”.

A vestige of a striving former self dating from somewhere between 1963 and 1968 gibbers from his decaying grotto in my cortex that seizing such succulent opportunities might have persuaded his employers to take him seriously, to extend his contract beyond the minimum that MRC allowed and ease him into a career far more glittering than the one we actually managed. (His moans “Too late! Too late” echo the snideness of our cleaning lady, Lavinia, about my rusty exercise bike). The clapped out current-self now in charge of my life mumbles that the journals seem to be new ventures by unknown firms in Madras, Beijing and Singapore, that we do not recognise any of the Editors or Board members and that, although though I have nearly finished reading each of three paper-backs on Quantum Dynamics for Dummies it may be too soon to submit “Speculations on consequences of collapsing the quantum probability function for slowing of decisions in Old Age”, even for “guaranteed immediate publication”. Clearly these people know and care as much about me as much as do warm-hearted Nigerians who salute me as a Brother in God and offer to deposit astounding sums of $US in my bank account.

But today is different (as today always turns out to be). An e-invitation from a respectable publishing firm for whom I have often produced work offers me a chance to do something that I might still, actually manage!

“Given your expertise in this field, we would be absolutely delighted if you would agree to produce a video for our Psychology Video Collection, to be released in March 2016. We notice that you were the lead contributor on the following concept published in the Encyclopedia of the Mind edited by Harold Pashler in 2013:

Aging Memory and Information Processing Speed

Might you be interested in creating a video discussing this concept in your own words?”

Well ! How very, very nice! Not just slog out yet another grey typescript but re-cycle MY OWN WORDS and speak them, with accompanying smirking, and possibly even some modest prancing and posturing, sharing my trove of wit and wisdom about Geriatric Reaction Times with the eager young ! Who knows where this may lead? Breakthrough to a personal BBC TV slot on “Slowing of Information Processing in Old Age” seems an implausible fantasy but being recognized in the street by charming young people warmed by a winsome introduction to the wonders of The Brinley Function might, surely, plausibly happen? Even once or twice would be very nice?

So: To the meat of the deal:

“We’re keen to receive videos by October 16that the latest, so we’d be very grateful if you would confirm your interest as soon as possible — but please do ask if you have any questions! Please feel free to simply reply to this email if interested. We will receive your response! “

Undertaking to reply to my response would have been more reassuring but of course I immediately clicked to a new screen where my questions were answered:

The publisher will retain all copyrights.

The publisher will give no help with preparation of the video (though presumably, if they are wise, they will wish to rigorously edit and demand revisions of submissions).

“Unfortunately” there can be no guarantee that institutions or funding bodies will find these productions evidence of merit when comparing candidates for tenure, promotion or support.

The deadline is inflexible.

Like all deadlines it seems at first to be comfortable eons away – at the end of what my generation of academics used to call “the long vacation”. Though I am no longer employed I estimate that, because I am now slow and have no technical back-up, writing a transcript of a course, making a video and editing and re-editing these to satisfy a publisher’s production team would take me about 200 hours.

I will be paid nothing but I will get to keep and use (with some stringent restrictions) a copy of my transcript and video.

The publishers are clear and honest about their proposition but why do they think that I might go along with it? Perhaps, as with incredible Nigerian offers the crafty strategy is to locate uniquely credulous persons who are the most likely to become malleable contributors? Have I been fingered as an old fool who now has more spare time and frustrated vanity than common sense? Maybe; but I imagine that similar proposals will go to young people who are still very active in research.

Ever since Grub Street a haughty response used by firms of publishers to put down authors is that they are not mere commercial enterprises. They are far sighted, energetic and warm-hearted professionals who take up the huge task of knowledge-dissemination without which Science could not progress. They strain their generous hearts and keen commercial brains to benefit underpriveledged students in universities that cannot afford to buy runs of their (grossly overpriced) journals or to pay competent lecturers to design and give courses. They propose to do this by marketing compilations of selected papers and, now, entire courses of canned video-lectures. Crusty superannuates may begrudge a few hundred hours to share their fading knowledge with some of the neediest students in the world. Some, like myself, may even grumble at writing journal articles for nothing or resent paying serious sums to get them considered by other experts who are paid nothing for this trouble, or carp at reviewing other peoples’ articles for free or demur at unpaid editorial jobs processing scores of Ms. and oversee production of the journals in which they appear. Selfish shirkers just do not get the point that without contributions of our surplus time publishers simply could not afford to do the wonderful job that they do (e.g. Elsevier’s annual profits are barely more than 30% of their gross turnover).

We cannot blame academic publishers for making strange suggestions – only ourselves for tolerating an environment in which they seem normal. Unless results and arguments can be made available to as large a community as possible to be checked, developed, and to become part of a global culture there can be no science, or only very small and very slow science. Do we really need publishers for this? As the soubriquet suggests “Academic” publishers were essential when most scientists were “University Academics” but we have since passed two different historical cusps: First, transmitting what we know no longer depends on skilled management of a chain of complex processes beginning with the destruction of trees by heavy machinery. Second, up to 70 of working scientists are no longer “Academics” in Universities that strive to find ways to grade our achievements so that they can reward, tolerate or dismiss us – and use counts of citations of papers in “academic journals” as the least-bad metric to do this. Most do their research in Industry or in other kinds of institutions that have developed sophisticated means of internal and external dissemination of knowledge. Mathematicians and statisticians can personally post their results digitally, time stamped to establish priorities. A cheap desktop computer can share all we know with anybody in the world. Retired academics no longer have to maintain support by University Departments by notching “citation counts” or other “productivity indices.” We are free to samizdat our own collections of digital papers, lectures, and even instructional videos, publicise them on easily usable public forums for virtually no expense and give them, free, to any who may find them useful. For sure this takes time, – which we have in abundance – and energy – a much scarcer commodity. Nevertheless I promise you, from my small personal experience, this is far more fun, and results in personal interactions that are much warmer and more rewarding than the tepid transactions we have had, throughout our working lives with huge prosperous institutions that we have labored to support.

For a much more detailed analysis of the problems and new possibilities of academic article publishing in the digital age please see

Sheila Hancock, an actress who has given pleasure to thousands for decades, is a veteran motorist who has driven for 60 years, has had no driving accidents for which she was to blame and so has made no insurance claims. The Admiral Insurance Company celebrated her 82nd birthday by raising the premium for her 3-year old mini-Cooper from £873 to £ 2,246, i.e. £ 1373 in a single year. She shared her outrage with the Guardian Newspaper who researched actuarial statistics showing that, on average, claims by drivers aged from 18 to 20 average 67%, from 46 to 50 66% and from 76 to 80 65% of the premiums that they pay. Accident rates are highest in the teens and twenties, lowest in middle age rise only very slightly during the 70’s. So that these equalities mean that, from our 2nd to 7th decades insurers vary our premiums according to our projected accident costs. After age 80 these reassuring equalities break down. Surprisingly for those still driving in their 90’s insurers’ accident-cost/premium ratio drops to 52% so that insurers make 13% to 15% profit from nonagenarians than from teenagers. The Guardian quotes no accident cost/premium ratio for 80 year olds but, irrespective of car-type or claims history, it seems that an average 82 year old pays £392 while an average 62 year old pays £286 and this difference is increasing. During the past year average premiums have risen by £35 for 80 year olds but dropped by £50 for teenage drivers. Do sharp declines in driving competence in the late 70’s and 80’s justify this? Accident statistics show only a very slight rise in reported accidents between 70 and 90. This is not completely helpful when comparing claims costs that may reflect different kinds and numbers of accidents which may be more to less expensive for insurers.

Another difficulty is that as populations age so decade-group averages become increasingly poor indices of ability. In spite of clear everyday evidence we tend to ignore the blatant fact that variability in competence between people increases with group age so that differences between the least and most capable markedly widens. The most able 70 year olds in the UK are still running industries, steering politics, writing excellent novels or scientific papers or, like Ms Hancock, giving delightful performances but between 30% and 45% percent of their co-evals need sheltered accommodation or full-time care. In our Manchester longitudinal study a dwindling number of volunteers showed little or no measurable changes in mental ability as they aged from 65 to 85 but increasing numbers of their less fortunate peers suffered illnesses such as cardiovascular problems and diabetes that caused rapid losses of competence and earlier deaths [1,2]. We must expect that as motorists age a diminishing few will remain competent through their 60’s, 70’s and even in their late 80’s or 90’s, but an ever increasing majority will become at risk. Are there more convenient and fairer measures than accident statistics to discover motorists who are becoming risky so that they can give up driving before their increasingly probable accidents happen ?

My personal research on some problems of older drivers showed me that trying to answer this question is not only very hard but can get one into highly emotional discussions. Pragmatic traffic policemen saw me as a deranged scientist recklessly keen to unleash hordes of grey slayers. Older motorists saw me as a callous age-traitor, keen to snatch away their small joys and freedoms. How to recognize unsafe elderly before they cause damage? My favorite anecdote, to hint that this might not be easy, was that during most summers newspapers print stories of elderly drivers who bravely set out from their homes and are discovered, a day or more later exhausted and dehydrated in some distant part of the country. Obviously they were at grave risk while they were lost and bewildered, and we might well advise them to give up driving. But…….. We must nevertheless recognize that they have driven for very many hours and miles, often in a state of terminal fatigue, and without causing an accident. One explanation is that perceptual and motor “driving skills” sometimes seem to survive gross confusions of higher order thinking. Another is that the vigilance and competence of other road users makes the driving environment more forgiving than we usually suppose. (Current easy availability of GPS and other in-car navigation systems is probably not a good solution for such unfortunate geographical derangements because, as motorists grow older they have greater difficulty in attending to two things at once. This not only makes them uncertain in heavy urban traffic and at busy intersections [3] but particularly confuses them if they try to simultaneously drive and follow a GPS [4]). Road traffic policemen and other experts were generally unsympathetic and countered my tales of accident– free driving by deeply confused elderly with accounts of roadside checks that pick up oldies who, even when wearing their spectacles, are so visually disabled as to be almost blind. My ripostes with data from elderly motorists in Marin County California who responded to visual difficulties in a timely way in spite of great personal inconvenience seldom cut any ice [5] If people cannot recognize that being nearly blind puts them at risk how can we trust them to become aware of their more subtle problems?

There is a huge literature on when and why people give up driving. A 1995 U.S. study of the driving expectancy of 4699 motorists aged 70 and over [6] found that those aged from 70 to 74 could expect another 11 years of driving, often terminated only by their deaths but also by voluntary withdrawal. In a typically thorough 1992 Finnish study [7] all license holders born in 1922 were asked how and why they had decided to stop or continue. The main reason for stopping was poor health, though most also reported increased driving stress. All but 6.9% of those who had given up said that they had done so without advice from family, friends or medics. Like all other surveys this study also found that withdrawal from driving is not an abrupt decision but a gradual process. Older drivers gradually drive less, year on year, and become increasingly selective about the times of day and the routes on which they drive until they discover that even reducing difficulties in this way is not enough, and give up completely. A key point is that this self-modification of driving behaviour does, in general, seem to work very well. The numbers of accidents for older drivers who maintain a high mileage are equal to, or less than those of their peers who now drive much less [8]. Clearly self-monitoring is effective, and people know when they are still safe and when they are beginning to be at risk. Recognition of driving stresses alters their behaviour until they finally stop driving, in spite of the strong temptation to give themselves the benefit of the doubt. Giving up driving is hard, particularly for men, who tend to feel that a car is essential for more aspects of their lives than women do and people living in rural areas may have very little access to other forms of transport to manage their daily lives. US studies have found that having to give up driving greatly attenuates the lives of both men and women by shrinking the already sparse range of out-of-home activities that remain possible for them [8]. This difficult decision can be eased by provision of check lists such as the “Driving decisions Workbook” [9] or the Manchester Driver Behaviour Questionnaire [10] which, by probing their memories of difficulties they have encountered in various driving situations can help them to become more clearly aware of their problems – or, indeed, to relieve them of anxieties and more cheerfully plan their remaining driving careers.
So, rather than simply stopping people from driving at some determined age or waiting for them to disqualify themselves can we find “gold standard” tests that will identify older drivers who are becoming risky ? A study of 1910 elderly drivers by Karlene Ball and colleagues [11] found that among individuals with adequate vision, being older, being a man, having a history of falls, having poorer scores on a behavioral test of frontal lobe function (the “trails test”) and on a complex test of attention (Ball’s useful field of view test) all predicted future risk of self-at-fault crashes. Most other studies roughly agree with at least some of these findings, but there is a growing consensus that health problems and the biological changes accompanying old age are even more powerful predictors. Reading about Ms Hancock’s confrontation wither the Admiral Insurance Company made me re-visit data gathered and published many years ago on a sample of 555 gallant Manchester volunteers who not only took a battery of more than 50 different physiological and mental tests but agreed to be evaluated, while driving their own cars, by experienced driving instructors (see, for instance, [10] and other papers by the same authors). The conclusions, given below are from an exceptionally thorough re-analysis of this data-set by Mei Foong Low [12]. As in other analyses of this data set Mei Foong Low found that quite simple biological indicators such as strength of hand-grip or the maximum force of leg-thrusts and a measure of lung capacity did significantly predict both whether or not individuals has experienced any accidents during the last 5 years and how many accidents they had experienced. The new twist was that if drivers’ self -reports of all illnesses with which they had been had been diagnosed were also taken into consideration predictions from grip strength, leg-thrust and lung capacity were greatly weakened or disappeared. This suggests that these rather arbitrary and peripheral measures of well-being mainly pick up differences in general health status and wellness that are more basic determinants of driving skills. Among other significant predictors were peripheral vision, hearing, balance, joint flexibility and of decision speed and attention, including the tests of attention and of frontal lobe function included in the study led by Karlene Ball. Though, in our study, neither Ball’s test of frontal function (the Trails test) nor her test of attention (The Useful Field of View test) significantly predicted frequency of accidents, two of our other tests of attention and decision speed did. However the catch was the same as has been found in her study and in all of the others that I have read. While statistical tests confirm that associations between peoples’ scores on some tests test scores and their accident records are significant, in the sense that they are much stronger than we would expect to happen by chance, no test, or measure, or combination of measures has accounted for more than a very small amount of the huge variability between individuals. In fact even our” best” tests accounted for no more than 2% of the total variation in accident records between people. In short, within a very large group of people those who had poor test scores were indeed more likely to have had accidents the power of this prediction was so low that it would not be sensible or fair to make decisions about whether particular individuals were at risk only on the basis of their test results. Among many possible reasons why they are such weak predictors is that the vast experience of driving that individuals gain during their lifetimes compensates for other declines in their mental and so emerged in Mei Foong Low’s exceptionally thorough analyses as a significant predictor of their accident records.

I would love to encourage the scintillating Ms. Hancock in her confrontation with her insurers by giving her numbers to persuade them that because we are all so very different from each other, and because these differences increase as we age, it is grossly unjust to lump all of us into very rough categories so that the most able and harmless of us can subsidize the costs of the more dangerous. I am sure that this is the case, and that more effective and equitable means must and can be found. I am very sorry that this is not yet, and certainly not by me.

My last 60 years in cognitive gerontology have been very happy and interesting but this long perspective has drawbacks. New researchers recycle confused old ideas and new journalists enthusiastically spin their muddles. A well-conducted and analysed study by Hartshorne & Germine [1] again assures us that, as we have known for 70 years, our scores on simple problems of the sort used in “intelligence tests” [2] peak in our mid- twenties and then decline. This is not the best possible news but panic is unnecessary because these losses are small and slow [3]. Also throughout our lives we continue to learn useful new skills that we can practice and keep in old age [4]. Hartshorne and Germine try to cheer us up further with reliable new data which, they claim, shows that we have different kinds of intelligence and that only some of these fade early while others are ripe autumnal fruits of maturing minds. I should be thrilled by this, or by any suggestion that some of my abilities might decay slower than I fear. What is it about Hartshorne and Germine’s well-written paper that makes me irritated and depressed?

Throughout our working lives my colleagues and I have lived with slurs that psychology is a non-science (or, rudely, nonsense) because the results of our “so called” experiments lead to no reliable conclusions. This has not just been a mortification in pub bars and at dinner parties but a threat to our livelihood. During the 1980’s Sir Keith Joseph, Margaret Thatcher’s scarily clever Secretary of State for Education and Science, publicly maintained that while proper sciences like Physics, Chemistry, Medicine or Biology continually progress from incrementing bodies of reliable knowledge psychology and other “social sciences” are not “cumulative” because they endlessly rehearse the same arguments from unconvincing data. This is a costly bad rep. Unfortunately I think that Germine and Hartshorne’s breathlessness at discovering late maturing “face recognition intelligence” illustrates that bad old Sir Keith had a point.

A chronic problem while doing psychology is that we try to find quantifiable descriptions and precise explanations of our feelings, capabilities and everyday experience but, for thousands of years, this entire territory has already been thoroughly mapped in everyday language. In common conversation the rich vagueness of words like “intelligence” allows illuminating ambiguity and metaphors so that it is quite in order, and even helpful to speak of “chess intelligence”, “emotional intelligence” or “soccer intelligence” and we all know exactly what is going on when we do this. In psychology the word has a less generous and scintillating penumbra of meaning. Binet [2] first showed that the speed with which children can solve simple but unfamiliar problems very strongly predicts how well they will do at school, even at subjects that they have not yet attempted. Hundreds of convincing studies continue to find that, at any age, tests that measure speed of problem solving are practically useful because they identify individuals who can learn new mental skills faster and perform them better than others can. To call this ability to solve simple problems quickly “intelligence”, and so to call particular sets of simple problems “intelligence tests” has been an irresistible, tedious mistake. Wiser researchers, like Charles Spearman spoke of “gf”, (“general fluid ability”) to signal that it is a capacity associated with better performance on very many different kinds of mental tasks and also that it is a statistical construct that has been defined by factor analyses conducted to find common variance between the scores that thousands of different people achieve on different sets of problems. Further work found that peoples’ scores for geometric and symbolic problems are strongly, but incompletely related to their success on problems expressed in words and that men, on average, score slightly higher than women on spatial tests. To compare scores on these different kinds of tests is reasonable because in both cases the problems are chosen to be sufficiently novel that peoples’ results are unlikely to be affected by their different, previous experiences. Other contrasts between scores on different kinds of tests cannot be interpreted in the same way. Women often have larger and more precise vocabularies than men and both sexes can keep, or even increase their stocks of words in old age. Since all words must be learned it is not surprising that interest in new words might differ between genders or that vocabulary takes years to peak.

John Horn and Raymond Cattell [5] were among the first to articulate this difference between the ability to solve many different kinds of novel problems and to learn new things, which they termed “fluid intelligence”, and the possession of stocks of words, social skills and, by implication, gradually acquired knowledge of faces which they termed “crystallised intelligence”. To call our mental dictionaries and thesauruses “crystallised verbal intelligence” was irresistible, but a bamboozlement. Using the same, richly vague common-language word “intelligence” for both the ability to process and learn new information and for deployment of learned stocks of familiar information has caused banal category confusions. A helpful analogy for the contrast between “fluid intelligence” and “verbal intelligence” is that while the speed and processer bandwidth of a computer will limit how rapidly it can enter and compute with new information of any kind the capacity of the memory in which it stores the particular programs and information that it needs to do a specific task is an entirely different benchmark characteristic, – both in terms of hardware and in terms of function. I know of no pub or bar in the world in which fellow-drinkers would fail to recognise the distinction between our ability to do particular things that we have spent years learning how to do well, and our efficiency at learning any new thing. After all, we barflies have been talking about ourselves and each other for thousands of years. None of us would be surprised to be told that peak ability at “vocabulary skills” or “face recognition” or “people skills” (aka “emotional intelligence”) may take extra years to attain because they require decades of encounters with words, people and faces.

Why do able and methodologically sophisticated psychologists like Hartshorne and Germine gloss this trite distinction? Jim Coyne and other self-styled “activists” in the pursuit of error and obscurantism in science draw attention to the powerful market-forces that drive academic journals to prefer papers that are likely to gain media attention over those that offer undramatic, but in Sir Keith Joseph’s language “cumulative” knowledge about ourselves. Now journals ferociously compete with each other for reputation, and so sales. The currency of reputation is “impact factors” derived from numbers of citations of published articles. Media attention to journal articles boosts citations so that preferring articles with “media appeal” has become a potent weapon in Journal-Marketing. Any repeat of a hackneyed old result can be spun. Since the careers of scientists also depend on citations Hartshorne and Germaine may well be pleased at media attention. In their particular case an able journalist, Kayt Sukel [ 6 ] has behaved impeccably. She not only mentions the Horne and Cattell work but sought and quotes advice from a formidable authority, Ulrich Maier, currently Editor of “Psychology and Aging” who said exactly the right thing: he found Hartshorne and Germine’s findings unsurprising because decades of work since the 1930’s [ 6 ] has shown that both outstanding and mediocre scientists, literary figures, musicians and artists, as well and bankers and business managers, reach their various peaks of performance in their professions at different ages. Understandably Sukel simply offers Maier’s tolerant ennui and Germaine and Hartshorne’s enthusiasm without sharpening a point by contrasting them. An article that simply said “Old idea checks out again” would hardly be widely noticed.

It is not helpful to ask “Where did the spin begin?”. The pass was already sold once Binet and every psychologist adopted the word “intelligence”. Horn and Cattell made a useful distinction between the age-fragility of innate abilities and the durability of learned skills but fumbled this by using the same, richly imprecise, word “intelligence” for both. So my old colleagues and I have stood for decades in the shabby little village fairground of our subject watching the same tatty old misconceptions going around and coming around like the wooden animals on Rilke’s carousel – the horses, the lion, the deer and every now and again this same battered old white elephant [7].

]]>https://outlookfromhutch.com/2015/06/21/multiple-intelligences-in-old-agewhere-did-the-spin-begin/feed/0pmar76Carouselwhite elewphantAge, Committees and the Power-point Revolutionhttps://outlookfromhutch.com/2015/05/28/age-committees-and-the-power-point-revolution/
https://outlookfromhutch.com/2015/05/28/age-committees-and-the-power-point-revolution/#respondThu, 28 May 2015 16:59:03 +0000http://outlookfromhutch.com/?p=534Continue reading →]]>During fifty years of paid employment I became blasé about Committee Meetings but in retirement I forgot many things I had learned in cheerless rooms: guessing which curly-edged sandwiches have least-worst fillings; the ritual self-positioning of Committee-members in their, obscurely, favored seats; their preliminary interventions advertising who they are, what they know and how extraordinarily well they know it; differences between individuals’ theoretical and practical grasp of affability skills; the honed geniality of chairpersons; manic fixed beaming of some participants and poker-faces of others.
Unexpectedly I have again attended some meetings. Things have changed. Now that I am visibly old people are disconcertingly helpful. If they find me lurking in corridors searching for the Committee-Room they do not ask where I want to go but simply tell me where the toilets are. They explain lift-buttons to me. They do not jostle me at the sandwich table but give me too many paper-plates. They smile kindly as I fumble in my rucksack for my tatty notebook, the one ballpoint of four that still works and my two pairs of spectacles – one for writing and the other for screen watching. Then, gradually, boredom seeps from the buttocks up the spine and neck to the brain bringing subtle and particular flavours of ennuis distilled from a lifetime of forgotten meetings. But a dazzling new thing has happened while I have been away: The Power – Point Revolution !
Back in the day power-point slides, at least those used by respectable cognitive-aging persons, were simple black-on-white lists of bullet points to remind us what to say next rather than to distract audiences from our verbatim rehearsal of exactly the same words. Power-Point virtuosi, often women, might introduce sprigs of flowers or flowing pastel smears around their text. Brasher mavens caused arrows to prance between numbers or bits of text to drop suddenly into the screen, often with loud twangs. Graphs were very simple and often wonky, encouraging audience participation with demands for return to slide 93 (where error bars had been forgotten or axes reversed so that the data precisely contradicted the speaker’s argument). Tables were grey chicken-wire-fences of tiny illegible numbers. But Now! A New Age has dawned, all is changed utterly, and a terrible beauty is born. To de-construct these astonishing changes we use techniques borrowed from Art Historians.
Hindsight reveals a transitional period from bullet-points and bad graphs to “Mature Early Power Point”. This reached its apogee of complexity with Structural Equation Model Diagrams. Blobs of various shapes, some designating particular classes of variables and some intriguingly arbitrary were each labelled in tiny print and joined by arrows whose directions were critical to arguments that could alternatively be expressed in equations, numbers or even words. Arrows were often labelled with very faint numbers indicating relative weights. Slides increased in complexity until their full flowering in a phase that my colleague Cameron Camp termed “Thanksgiving Turkey School”. At this point Power-Point theory moved beyond any pretence that slides are simplified and condensed representations of arguments. In what we may call the “Transitional Pre-Contemporary Period” divorce of blob-shape from variable class became complete; all arrows were logically reversible in direction though, with coy playfulness, they were still given single barbed heads; complete omission of numbers signalled disdain for quantification. To emphasise the new freedom diagrams sometimes, with charming caprice, were split into two or more independent, unconnected sections.

As with all Art Movements new ambitions required a new vocabulary. Increasing use of words such as “Eudaimonic” has became a signature of the period. The unwary will decode “Eu” as a prefix meaning good, or pleasant, and “daimons” as subordinate characters in a Harry Potter Saga. Not so! The cunning authors have set a witty trap! A recent source explains “ Some researchers claim that eudaimonic well-being is best achieved through personal development and growth , others through finding meaning in their lives. One way or another, they agree that there must be something else out there in addition to pure pleasure and happiness.” [1]
In other words Contemporary power-point slides now try to express the numinous or indefinable. The core of the Power-Point Revolution is that slides no longer aim to illustrate or reference any argument. We transcend weary convention to gallantly eff the ineffable.
The next, Post-Transitional, phase, we provisionally call “Early Mandala” [2]. This taps deep roots in the the human psyche. For example, very long ago I used to decorate my school notebooks with” Pat Rabbitt, 272 The Tideway, Rochester, Kent, England, United Kingdom, Europe, The World, The Solar System, Nearest Galaxy to Andromeda, The Universe” ( The Multiverse was not then imagined). Post-transitional slides cheekily retain the refreshingly naivety of childish scribblings. An early example of this genre is a “Pre-concentric” or “Cascade Mandala” slide from NICE [3] on inequalities of population health. This is clearly “British School”: whimsically top-down from general to enfold and even to cuddle particular points:

A currently dominant trend shifts from British Cascade to “Tibetan School” with concentric circles with embedded legends. A fine recent “Model” (Mandalas are always called “Models”, except when they are diffidently called “Frameworks”) is a diagram by Bath and North East Somerset Council in a document discussing Provision of Public Toilets [4].

This is a breathtakingly complete depiction of a Total Universe of Public Toilet Provision! The global ecosystem with its hints of possible climate change and their effects on global biodiversity envelops concentric circles of increasing particularity until we reach the still centre of “People”, with their defining qualities of Age, Sex and genetic diversity. I am completely convinced of the importance of Age and Sex in toilet provision but less so of Heredity. Nevertheless, we must open our minds to all possibilities of future discoveries. Who knows what Genetics may yet reveal?

It is crucial to grasp that contemporary Power-Point Mandalas are not representations of any “things” or “arguments”. A Mandala is, rather, a noumenon, a ding an sich that needs no link to, or constraint by artificial ideas of “reality”. It simultaneously hints at all, and no, possible interpretations. The text in which the fine Bath and Somerset Toilet Provision Mandala is embedded never refers to it as a scaffold for an argument. The aim is to convey insights beyond verbal definition: in this case the implication of God-like overview by a benevolent Local Authority.
As always in Art History we can track emergent themes through temporal and geographical variants. In an instructive adaptation by the University of New South Wales Social Policy Research Centre [5] the still core of the gyre shows cryptic Words of Power: “Holistic SEWB”. Clockwise arrows in the outer circles do not signify directions of causality or flow of relationships. They are there only to convey dynamism and urgency. Charming homage to Aboriginal dot-paintings and a colour scheme borrowed from yellow and ochre pinjun desert sand are Australian signatures and by no means accidental attributes of this remarkable “Dreamtime model”:

An example in a brochure by Yukon Wellness California [6] shows how, the outermost circle wittily recalls and mocks a fusty convention that “directional arrows” signify causal links. Here arrows are replaced by brown, khaki and blue diamond shapes, squiggles and semi-circles. So we gently but robustly expose as obsolete the fiction of connected arguments and causality.

During years of retirement I have wasted my time by dully continuing to analyse numbers and to write old-fashioned papers about the patterns I find in them. I hope that I am not yet too old to appreciate, and even to adapt to this huge, enthusiasts might even say “Tectonic” shift in the nature of representation in my field. I have begun work, as hard as my age allows, on a Universal Reaction Time Mandala with compartments for Simple and Choice RT paradigms, serpentine tracks of repetition and fore-period-duration borrowed from Kalahari Bushman Stone Etchings and, as due homage to Wilhelm Wundt, symbols in Deutsch Schrift symbolising trial – to – trial variability, signal discriminability, and choice of responding limbs. I am at last ready to come out of the closet of humdrum explications of “processes” and “mechanisms” and to dare to depict, in glorious entirety and in many cheerful colours a universe in which Reaction Times simply…… exist ! I shall offer this “Model” gratis for use in Brocuures and grant proposals by Local Governmental Authorities, Boards of School Governors, Big Pharma and miscellaneous Sociologists as a revelation and celebration of how the Science I once practised has been transformed in the few years while I have been distracted from its astonishing progress.

]]>https://outlookfromhutch.com/2015/05/28/age-committees-and-the-power-point-revolution/feed/0pmar76Health Inequalities and Population HealthBath Toilet MandalaTristanSchultzArtwork Seven Domains of social and emotional well-beingholisticmodelwellness-Yukon Wellness CaliforniaHot and Cold in Old Agehttps://outlookfromhutch.com/2015/05/11/age-and-global-warming/
https://outlookfromhutch.com/2015/05/11/age-and-global-warming/#respondMon, 11 May 2015 16:35:12 +0000http://outlookfromhutch.com/?p=509Continue reading →]]>

Oxford Springs are slow and deceitful – tiny progress cancelled by returns to grey dank – but this April was wonderful. The Met Office says it has been the best ever recorded. I sat and read in the sun on the kitchen roof and saw my extremely eminent neighbour, 50 feet away, cautiously de-hibernate and open his bedroom window for the first time in 5 months. We waved, reaffirming for our 15th time the traditional British Neighbour Spring Pact: “ Better weather means that our images may more frequently fall on each other’s retinas but, notwithstanding this, no higher-level perceptual processing shall occur and, unless you or I begin to spontaneously combust, we shall never, ever, attempt conversation.”
Though kitchen-roof-tulips are out May is not yet wonderful. The tulips seem to like rain. I don’t. The Met Office thinks it will soon be warmer, drier and fit for roof-reading again. To prepare for the change I read what I can find about how altering seasons affect oldies like me.
Most Spring Poetry is unhelpful because it bangs on about young yearnings. Basho is better tuned to geriatric inner weather: “Spring rain leaking through the roof dripping from the wasp’s nest” reminds me to do something about Mason bees excavating the bedroom wall but does not launch my spirit into Vernal Trajectories. “Spring Air, woven moon and plum scent”? A little better, but hardly in Oxford? “Sitting quietly, doing nothing, Spring comes and the grass grows by itself” catches the mood but also reminds me that the lawnmower is rusty. Paraphrased for those who are no longer at his imaginary perpetual “one-and –twenty” Houseman was a gloomy old toad, even in Spring:

“Of my three score years and ten,
Sixty will not come again,
To take from Seventy springs this score,
Only leaves a decade more”.

(OK, OK, Alfred. Just stop going on about it).

Do epidemiology and cognitive gerontology have anything interesting to say about the way human spirits swing with the seasons?

The German Federal Bureau of Statistics publish data that most North-Northern Hemisphere residents will recognise. Between 1946 and 1995 deaths were most frequent between January and March, fewer during Springs and least in Summers [1]. The analysts speculate that greater mortality was related to lower temperature since it reduced with spread of domestic central heating. There is a well-documented Winter increase in incidence of cardiovascular problems, including myocardial infarctions and Strokes. This is followed by a fall in Spring to a Summer low which is more marked for old than for young [2]. An analysis of Japanese Vital Statistics between 1970 and 1999 sharpened this point by including simultaneous weather conditions. Deaths from infectious and parasitic diseases, tuberculosis; respiratory disease; pneumonia and influenza; heart and cerebrovascular diseases; diabetes; digestive diseases and accidents all peaked with low temperatures in Winter but Suicides peaked with high temperatures in Spring and Autumn [3]. Italian suicides from 1984 to 1995, (31,771 males and 11984 females) also peaked in Spring and then dropped to an Autumn low for both sexes,- but this was true only for suicides by violent means. Non-violent suicides were evenly spread throughout the year. There were similar numbers of violent and non-violent suicides but a wider literature suggests that their causes are not the same. Violent suicides seem to be passionate events related to disturbances in relationships at higher temperatures. Non-violent suicides are more often due to other chronic miseries. This story seems plausible but, if it is true, it is odd that the proportion of violent suicides should not decline with age and that seasonal differences in numbers of violent and non-violent suicides were greater for the old [4].

Seasonal changes affect depression and mood. A small study found that 250 Boston women aged 43 to 72 were more Tense or Anxious, Depressed or Dejected, Angry and Hostile, Tired and Inert and Confused and Bewildered in the Autumn, but much better in the Spring and Summer [5] 400 mgm supplements of Vitamin D (which we need sunlight to produce) did not help. Differences might also have been associated with opportunities for exercise which followed similar trends. This is important because in the N. Hemisphere winters keep elderly people indoors where they are not only bored and isolated but also inert. A British study found that older people were slightly more miserable in the Autumn and Winter than in the Spring and Summer [6] and cites other studies that have found parallel, but much greater, differences for young women of child bearing age. I am sure that a bleak winter’s day imprisoned at home with one or more infants is far more frustrating than quiet isolation in a warm room with a book or a lap-top. Increases in sadness with onset of Autumn and the progress of winter are common. In extreme Northern latitudes they are sometimes so severe as to qualify for a specific psychiatric diagnosis, “Seasonal Affective Disorder” (SAD). A Swedish review of published studies suggests that, in Sweden, it is common to be glum in Autumn and Winter and that the incidence of the most severe manifestation of glumness, SAD, varies from 0% to 9% and increases the further North you live [7].

So, with the Spring Equinox now well behind us, Northern oldies swing from SAD land into glad warm Summer. We shall read in the warm sun, get out and walk about much more and take the cheering exercise that we have avoided throughout a long dull winter. If we commit suicide there are greater odds that we will go out violently with a bang or a squelch rather than just a plaintive whimper. With global warming now evident the likelihood of heat waves and other extreme events will surely increase. Will this be a good or bad thing for our survival and morale ?

Recent studies anticipate problems for older people. The problems of harsh winter weather are obvious but a Japanese study covering summers of 1968 through 1994 found significant rises in deaths of children and elderly during temperature peaks of 38 deg C or more. I feel that I am more comfortable at high temperatures than most of my friends are, and that a reptilian ability to happily bask has strengthened in old age. I am probably wrong. A small but useful study found that both older and younger people feel most comfortable at temperatures between 20 deg C and 22 deg C but also that the old have problems because their perception of temperature changes is so coarse and sluggish that they may not notice as they gradually chill down – or heat up – outside this range [8]. Analysis of records of elderly patients admitted to a French Hospital emergency department during the 2003 French heatwave found that 42 out of 246 had heat – related illnesses not diagnosed by their physicians and that living in institutional care and taking psychotropic medications were risk factors [9]. A study of heat-stroke deaths in Japan between 1968 and 1994 found that numbers rose sharply when temperatures rose to 38 or above and half were people aged under 4 or over 70.[10] I had been looking forward to The Great Warming, especially in North Oxford, but these numbers, and increases in counts of exotic pollens now wither my hopes.

So, back again to poetry in the hope of some relief from the realisation that when we all begin to freeze or fry we old, and the very young, will suffer before the rest. Robert Frost is not particularly cheerful, but at least is poised and balanced:

Some say our world will end in fire,
Some say in ice.
From what I’ve tasted of desire
I hold with those who favour fire.
But if we have to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.

I meant to post on ways to cheer oneself up in old age, beginning with the kind of psychotherapy that seems to be interminably extended conversations. These continue, for an hour on each of most days of the week. The process lasts as long as clients stay solvent and therapists healthy and sane. The post has not come off because of irritation with recent published memoires of such long intense relationships by some clients and therapists. I began to suspect that both of these groups collaborate to construct alternative life-stories until they agree on one that “fits”, hopefully, providing a plot for a life story that can serve as an explanation, possibly even an excuse, maladaptive behaviour and its miserable consequences. Any relation of these ingenious sagas to reality seems irrelevant and both therapists and patients insist that gains are unquantifiable (except, perhaps, in terms of the therapist’s income). Both parties seem proud of this, perhaps because it invests the transaction with something numinous and also because it blocks crass evidence-seeking questions such as whether clients who experience such talking therapy get better faster, or more completely that those who do not 1. Relieved from any obligations to test by evidence therapeutic relationships can be judged in the same ways as novels or poems: in terms of different levels and kinds of enrichment of experience. Perhaps this is why many clients move restlessly on from therapist to therapist and so from one theory of therapy (e.g. Jungian, Freudian, Transactional etc.) to another until they feel that they are getting the best return of interest and comfort for their fees. There is no clear evidence that any one analytic theory works better than others, but this apparent interchangeability does not question their validity any more than the fact that individuals prefer some poems or novels to others proves that literary theories are “wrong” or “misguided” or “unscientific”. Maybe we should agree to use formal techniques of literary criticism to assess the relative values of the life stories that therapists help their patients to weave rather than haggle over “recovery rates” from different therapeutic disciplines. Many of us, certainly I, have had our lives transformed by particular poems and novels. Sometimes even for the better.

Another block to a post on psychotherapy for the old is that I am beginning to think that a better way to learn to manage our attitudes to our lives is from the examples of our friends. People of my age become increasingly valuable to each other as we grow old together and notice how we each manage difficulties that we currently share or must anticipate. It would be crass for me to try to list the various ways in which this helps since I have a direct example from a school-friend who endeda long and diverse career as a Professor of Political History at the Hague.

“Good to hear from you. .. I am about to join you across the boundary into octogenarianism. That thought has had a deeper effect than I anticipated when considering the next decade. …. such reflection began more than a month ago, when I had to make first us of my help service. One afternoon I had another fall indoors. It was the usual occasion. I was walking with my stick, this time into the bedroom, suddenly felt dizzy and lost my balance. Miraculously, as in all incidents so far, I did not strike any hard object and break anything, but did end up stuck in a foetal position (second childhood?) between the wardrobe, the bed and a bookcase. What distinguished this occasion was that I could not free my legs enough to roll over and crawl to where furniture could be grasped with enough leverage to stand up. On three occasions when this has happened before I have wriggled serpent-like to the front door, managed to get it open, and asked a passer-by to help me up. Now I could use the speaker round my neck, and after about twenty minutes two large, strong young ladies used their key to get in and lifted me up. After checking I was uninjured they left me to experience recovery shaking on the sofa.

Anyway, the result was that I came to the conclusion that moving into a home for the aged with constant supervision might not be as bad as it has hitherto seemed (in 2011 I was in one for four days after an operation in order to recover. It was sociologically fascinating but not decisively attractive). ….. So the next stage will be to find out what I can get. Actually, I still get a weekly outing to do shopping and take a cappucino, thanks to the self-sacrificing Desiree, my partner now for 15 years. However, she actually lives and works in Leiden, so can drive here and back just once a week (a further factor is that she is basically afraid of driving…) She telephones to check on me, but in the absence of family ….. living nearby I really miss someone popping in and seeing how I am and doing things like changing light bulbs. In principle, that is what social services arranges.

On the writing front, my help against becoming totally gaga, writing every morning, has begun to run down. I’ve just finished another novel. It is about what happens to a history lecturer who, while in a long-term coma after a car crash, finds himself in late 19th century London and able to make real his favourite horror stories of the time, featuring Jekyll and Hyde, Frankenstein and Dracula, and play parts in them. For example, he proves that the real-life Jack the Ripper, identity unknown to this day, was in fact Mr Hyde. No pressure intended, but if you might like to read it… On that general front, I fear the writing-to-ward-off-senility device is becoming severely threatened by the knowledge that the chances of getting published are in effect nil. My last attempt to find an agent not so long ago failed once again. Even my ego balks at again taking the self-financing route, though my savings would be up to at least one more venture. The autobiography is currently affected by this mood, although a limited printout for friends only is possible.

That seems more than enough self-pity for now. ….”

On the contrary, my dear old friend, the cool absence of self-pity, the ability to maintain a detached and analytical humour about a bad situation and of ones’ prospects in it, and determination to continue to amuse oneself and others is a better lesson in living than I can find in psychotherapists’ memoires. Thank you for a master-class in How to do Old Age.

1. To summarise a very large and very convincing literature: They don’t.

In North Europe cold dark February leaches joy from elderly lives. So in Tenerife, every 10 minutes another plane unloads a new cargo of Northern Oldies seeking brief warmth and light but also hoping for restorative happiness. We crowd down gangways, beam at the unfamiliar sun and then face the problem of what to do next. Scores of custom-designed oldie-play-areas – “Resort Hotels”- anticipate a future in which a few cheerful, smooth, indigent young people earn a living by cosseting hordes of bewildered, crumpled, solvent elderly. We reach peak satisfaction every morning at primate-paradise breakfasts with omelettes and pancakes and fried eggs on demand and tables stacked with succulent stuff for us to load on plates or secrete for thrifty lunches. Then the food and crockery begin to disappear and we feel dearth of feasible fun. Shall we bask on sunbeds like disabled dugongs? Pay to be massaged, steamed, and have hot stones laid along our spines? Grab sweets from the reception desk as we exit to streets dulled by daily excursions wandering as mixed pairs of relatively mobile and optimistic women, each followed by a despondent man visibly wondering how his life has congealed and nostalgic for a comfy office and secretary forever lost to him in space and time ? Or sit in bars as bold singletons, burly, obese males and females flaunting speckled skin and seeking final solutions to the joy problem in huge glasses of mid-morning beer. Once we have got warm for the first time in months can we also manage to get happy?

Over 2085 years ago Epicurus thought that he had cracked the problem of geriatric joy. Like contemporary geratro-tourists in Tenerife he believed that since we have just one life the only sensible decision is to spend it as happily as we can. He believed that old age can bring peak happiness because demands of politics, careers and families have waned, freeing us to pursue the Good Life. His ideas on what constitutes the Good Life were, and still are, misunderstood. Unlike Epicures mis-named after him, or elderly guests at Tenerife resort hotels, he did not think that we can achieve lasting delight by finding and consuming the best of anything that may conceivably cheer us up, especially food and alcohol. At the entrance to his “garden” which seems to have housed an hospitable commune, a notice read “Stranger, here you will do well to tarry; here our highest good is pleasure. The caretaker of this abode, a kindly host, will be ready for you, he will welcome you with bread and serve you water, also in abundance…..” Epicurus’ sparse surviving writings insist that the key to enduring happiness is a sufficiency of bread, boiled legumes, water and endless philosophical debate about “the meaning of it all ”. I like to believe that, in practice, the entertainment in his garden was a little more lavish 1

I have spent far too much time in University common-rooms to buy the idea that, especially when philosophers are present, debates about the meaning of everything spontaneously ignite happiness. Even when the coffee is better than usual and the biscuits are Jammy-Dodgers or Fig Rolls. I do not think that boiled lentils and water would make things any better. David Klein2, a charming contemporary PR man for Epicurus, describes epiphanies during summer holidays on a Greek Island watching a small group of septuagenarians spend their days at the same table, in the same café playing cards, drinking retzina, scoffing mezzes and gossiping. With respect for Klein’s warm heart, a different café-frequenting philosopher thought that endless time with a few people who soon exhaust all of their anecdotes and opinions would be Hell 3. Another of Klein’s European epiphanies was encountering elderly Frenchmen attain delight while playing petanque. His pleasant Mediterranean images may encourage anyone who ever doubted that some old people can sometimes share bursts of communal contentment or even significant gladness. Some of us would like to hear more from the wives of boules players and barflies.

Klein makes valid points: even though many aspects of aging are not very nice, growing old can strip us of burdens of obsolete obligations and ambitions, and futile regret for “lives that came to nothing, or deeds as well undone ‘til death steps tacitly and takes us where we never see the sun”4. Such thoughts should free us to find new and to rehabilitate neglected sources of joy, or at least of mild contentment. But how to manage this?

As usual, after Philosophers have claimed all the best biscuits in the common room Psychologists rummage left-over crumbs. Between 1939 and 1944 the Harvard University Health Service began the “Grant study of Adult Development” by recruiting 268 undergraduates (including the young John F Kennedy). Between 1940 and 1945 Sheldon Glueck enrolled a further 456 young men from Boston neighbourhoods. 188 members of both groups are still alive in their 80’s and 90’s. George Valliant has summarised his conclusions from this vast database in his books “Adaptation to Life” and “Triumphs of Experience” 5,6. : Health is particularly important and determines happiness and economic success more strongly than genes do. Alcoholism is destructive of marriages, careers and contentment. Intelligence is a less important predictor of worldly success and happiness than is often supposed. Men who do well in middle age do not necessarily flourish in old age and vice-versa. Recovery from a wretched childhood is difficult but becomes easier with passing years; a happy childhood is a lifelong advantage; marriages become better when they persist after 70. Being affluent helps. Valliant’s most pleasant discovery (at least for me) is that elderly Liberals seem to have more and better sex than elderly Republicans. Apart from this last gem I think that I have already worked out all these conclusions for myself without the hassle of running and analysing a 70 year study. I find Valliant’s concluding summary bullet-point endearingly naff: “Happiness is Love. Full Stop”.

The Harvard study has lasted longer and probably amassed more disparate details of men’s lives than any other. However it only includes men, is based on small numbers and, perhaps for this latter reason, the most interesting questions that we might ask of the data are not addressed because there are too few representatives in different categories of persons to make sensible comparisons. Martin Pinquart7 explored a larger data-base by reviewing findings from 125 different studies. He concludes that old age seems to be accompanied by a slight decline in happiness (“positive affect”) and a slight increase in unhappiness (“negative affect”). As people age strong emotions, such as being joyously excited or acutely distressed are increasingly replaced by weaker feelings such as relaxation or mild depression. Pinquart acknowledges that in old age we become increasingly likely to experience unavoidable problems with poor health and economic stringencies. Nobody has ever thanked me for bringing up his findings in conversations about the odds of elderly joy.

Lacey, Smith and Ubel8 used Pete Townsend’s famous line “Hope I Die Before I Get Old; (the things they do seem awful cold)” as the title of a description of a study in which they asked younger and elderly adults how they feel about their present happiness and how they assess the odds of happiness at different times of life. Like Pete Townsend middle-aged adults thought that things will gradually get worse. The already-old agreed that, for most people, things probably do get rather worse as they age but cautioned that they were not speaking for themselves but only for others. Lacey et al point to a paradox of happiness studies: although people of all ages do not think that things get better in old age, responses from successive age-decades suggest that happiness actually increases after middle age with a possible, slight, decline after the mid 70’s.

This news is mildly reassuring but I have found nobody who is surprised or excited by it. It confirms that our worst fears about old age are unnecessary (or at least pointless, which is not at all the same thing) and that, as we continue to survive, things may get better, or at least will probably not become as bad as we fear unless, and until, we run into unavoidable hard times. It does not tell us what we all deeply, and secretly (for fear of being laughed at) want to know: “What is the best way to live and to be happy, whether in a resort hotel or while trundling through our everyday lives?” Many psychologists have tried to address this by analysing the answers that large numbers of people give to large numbers of quite simplistic questions. This tool does not seem fit for purpose. The excellent “Journal of Happiness studies” has published scores of studies in which people have been asked whether or not they are happy and whether they think that their past or future might have been, or turn out to be better than their present but I find no answers to the poignant question that we all continue to ask even though we suspect that no answer is possible: “How can I get joyful IMMEDIATELY and go on being happy ever after ? ”

My colleagues and I should not be mocked because our questionnaires and longitudinal studies do not cut the zesty mustard. Philosophers are luckier because they are free to reach conclusions without constraint of evidence and, anyhow, tend to divert along dull threads like “What does ‘being happy’ actually mean?” I believe that I have always known when I am “happy” and semantic exercises do not much amuse me or even seem to cheer up my philosophic colleagues. Religious Leaders have always been free to propose any solutions to the Happiness Problem that they care to imagine, and have become experts at marketing their fantasies but, even given these wide opportunities, they are surprisingly evasive. They admit that some who buy into their belief systems may achieve fits of sublime religious rapture but seem to disapprove of this. The main deal is that their faith can help us to accept everyday unpleasantness and boredom, and even to tolerate excruciations if we accept that these are what a wise and benevolent God has scheduled for us. Compensating gratification will be delayed but extreme: an eternity featuring an abundance of virgins (or plums, depending on the translation of the Koran that you choose), or choral singing and harps, or Elysian fields, or delight in ceaseless, gladsome praise or just Bliss Beyond Understanding (and so, also, conveniently beyond need for description).

“There is a happy land, far, far away! Where we’ll eat bread and jam, three times a day! Oh how we’ll laugh and shout, when the bread and jam’s brought out! We’ll all laugh and shout! Three times a day!”

In contrast Buddhists suggest that the best way to get through life with minimum fret is to be as nice as possible to everybody while learning to desire nothing and so become free from ambitions and regrets. They are pretty cagey about an afterlife. This seems similar to Epicurus’ recommendations, and quite a good idea.

The closest that respectable academic psychologists get to writing recipes for happiness is imagining, and then empirically testing, ways to reduce misery. Specifically, by treating depression, or helping people to recover from disaster, or to cope with uncomfortable lives. I have not previously felt any need to explore this literature because I have led an exceptionally lucky and amusing life during which I have been diverted from worries about attaining true happiness by obsessions with human reaction times and, more recently, with the effects on speed and intelligence of white matter lesions in the brain. My current desire to learn more about how to promote happiness is driven by curiosity rather than necessity (though, of course this may switch at any moment). I have learned that the best way for me to begin to understand something unfamiliar is to try to discover enough about it to write essays for an imaginary critical audience, just as undergraduates do for their tutors. So future posts will be my best tries at undergraduate essays on such topics as Mindfulness Meditation, Cognitive Behavioural Therapy, and other currently fashionable cures for little and large miseries, particularly those that tend to occur in late life. Of course I am very pleased and flattered if anyone reads anything that I write, and even happier if anyone cares to comment but, for my solipsistic exercises an imaginary audience will do just fine.

It is widely reported that guests in Epicururus’s “garden” also consumed hefty amounts of good wine. He had at least one rich patron who could have provided this, and perhaps some better things than boiled lentils.

David Klein, (2013) “Travels with Epicurus”, One World Publications, by arrangement with Penguin group USA. ISBN 978-1-78074-412-4

J. P Satre (quote from conversation) Hell is Other People.

Apologetically adapted from a verse in A Tocatta of Galuppi’s by Robert Browning